Monday, September 22, 2014

Free Market Medicine and Reality

Reality is things as they are.

Wallace Stevens (1879-1955), The Necessary Angel

I am a big fan of free market medicine. I am also a realist.

Free market medicine is a reality. It has an association, the Free Market Medical Association, with physician members in all 50 states, and more than 1000 participating businesses interested in cutting their health care expenses and promoting convenient care for their employees.

The Free Market Medical Association holds its first annual conference in Oklahoma City this Friday and Saturday. It will play to a full house.

Its theme is: “Thinkers, Doers, and Users: Forecasts, ideas, and how to create a free market health care practice How to practice free market medicine and how to use free market care to save money and get better results".

Speakers, all of whom are active in the direct pay independent practice movement, will address the following topics:

• Why the Free Market Boom

• Concierge Medicine – Direct Pay and Health Care Leadership

• Samaritan Ministries – Free Market Users

• Legal Green Lights and Red Lights

• Why I Posted My Prices

• How the Market Works

• MedaBid and Changing the Way We Buy Health Care

• The Free Market – Now, Next Year, and in Five Years

Charles Sauer, who is now executive director of the Free Market Medical Association; Keith Smith, MD, an anesthesiologist who co-founded the Surgery Center of Oklahoma; and Jay Kempton, CEO of the Kempton Group in Oklahoma City, who helps Oklahoma City employers find the best, most appropriate, most convenient, and least costly care for their employees, together co-founded the Free Market Medical Assocition and organized its first annual conference.

As I realist, I know direct pay independent practices, as exemplified in concierge medicine, ambulatory surgery centers, and other forms of cash-related practices without third party involvement are growing rapidly throughout the nation.

As a realist, I am also aware these direct –pay independent practices are ideally suited and work best for ambulatory patients, outside of settings directed by third party administered, regulated, and directed care.

ObamaCare News of the Day

This news in old enough, yet it is everyday’s news.

Shakespeare (1564-1616), Measure for Measure

The new news for ObamaCare is old news remains bad news.

The news as reflected in these three articles all say ObamaCare is headed for a fall in the November midterms.

1. Robert Ehrlich, “Affordable Care Act Lies, Baltimore Sun, September 20

2. Jeffrey Anderson, “Voter Intensity Strongly Against ObamaCare,” The Weekly Standard>, September 20

3. David Gergen, “ISIS Rollout Resembles Launch of ObamaCare,” The CNN Report, September 21

• Ehrlich, former Maryland Governor, former member of Congress, and now a law partner, reels off these ObamaCare “lies.”

1. Young people will love it.

2. Everybody will finally become covered.

3. Health reform will have little impact on employment.

4. You can keep your insurance if you like it.

5. The medical device tax is a moneymaker.

6. The health law will appease the progressive consciences.

7. The typical family will save $2500.

8. Nobody will deny you coverage for pre-existing conditions.

• Anderson, editor of the Weekly Standard, cites a poll indicating voters who consider ObamaCare “very important” oppose the health law by 70% to 30% and those who deem it “somewhat important” are against it by 51% to 47%. Those personally affected by ObamaCare or who have friends or relatives personally affected, say the affect been very negative (46%) or very positive ( 24%). By 71% to 27%, voters favor repeal of ObamaCare with replacement by a market-based system with health plans competing for price and individuals shopping for the best price.

• Gergen, senior CNN contributor, adviser to four Presidents, Harvard Law School graduate, and director of the the Center for Public Leadership at Harvard Univesity’s Kennedy School of Government say the President and his administration ought to get its act together:

“ With one hapless episode after another, The rollout of the President’s plan is beginning to rival the less-than-splendid debut of the ObamaCare website..In coming days, through his time at the United Nations and back in the White House, the President must dramatically seize the reins of leadership.”

Sunday, September 21, 2014

Patients, Physicians, and Pluralism

The theory that even if there is one basic principle many particular and distinct entities exist.


I belong to the school that says.

• America is basically a conservative right of center pluralistic nation that cherishess economic growth more than in political egalitarianism.

• America believes in equality of opportunity but not necessarily in redistribution of wealth to achieve equality of results.

• Diffusion of electronic communication technologies is making top-down autocratic homogenization of population behavior difficult, even obsolete.

• Conservative politics generate economic growth but result in inequality while left-wing politics redistribute wealth to achieve equality but produce economic stagnation.

• Finally, I believe these political philosophies will always swing back and forth in never-ending political and economic cycles with neither side ever convincing the other of the rightness of their respective causes.

At this moment in history, the U.S. and the world are caught up in the causes of pluralism vs. separatism. This dispute is exemplified by the struggle of who should control health care in the United States, the collective government or individual markets, by the Scottish referendum over whether Scotland should be independent or dependent on Britain, and by the Middle Eastern battles over which political entity should govern in that region of the world.

In his essay in this morning’s New York Times, Thomas Friedman backs pluralism over separatism “Three Cheers for Pluralism over Separatism.” Friedman argues everybody’s interests have be served and balanced with “no victor, no vanquished” among major players.

Friedman goes on to say America has always been a pluralistic country and concludes by saying we ought to have the wisdom to pass an immigration reform bill that enriches our pluralism.

Like most hot political issues, integrating the interests of those with different points of view is easier said than done.

As Peter F. Drucker (1909-2005), noted in his prophetic 1969 book, The Age of Discontinuity, in a chapter “The New Pluralism”:

“The private sector does not understand the government’s logic. Each rubs the other raw trying to work together, each resents the attitude of the other and is deeply suspicious of it, and yet each other is dependent on the other…Medical men see individuals. Indeed, none of us would want to be treated by a physician who treats ‘averages.’ But no government can handle anything but large numbers or go by anything but averages.”

But work together we must in a nation where 280 million of our 315 million citizens are dependent in one way or another on government subsidies: 65 million on Medicaid, 50 million on Medicare, 9 million on the VA, 7 million on ObamaCare exchanges, and a whopping 149 million on corporate health care tax credits for employers .

We must do so to preserve a society that is both competitive but cohesive despite our differences

Saturday, September 20, 2014

Electronic (E) Technology Doxology

Praise E-technology, from whom all blessings flow.


In God we trust, all others bring data.

W. Edwards Deming. 1900-1993.American statistician

Electronic (E) Technology has become a religion.

It's E-Technology here, E-Technology there, E-data here, E-data everywhere for every season and every reason as far as the Electronic Global eye can see.

It’s computer, mobile, and Internet apps. It’s Alibaba, the giant China E-commerce company. It’s Facebook, Twitter, and Amazon. It’s “Technology Lights Up Health Innovation Forum.” “It’s the Apple iPhone Takes Over the Street.” It’s “Leapfrogging the Democrat’s Tech Advantage.” It’s “Three Ways to Take Advantage of the Cloud.”

It's viral. It spreads through the ether, through the Cloud, from E-mail to E-mail, from Website to Website, from person to person.

It’s the multiplier, emusifier effect.

Why fool around with hundreds of thousands in the long term when you can reach millions, even billions, and disperse the information all at once?

Why wait for results when you can measure outcomes instantly with real data ?

Why be subjective with feelings when you can be objective with data?

Why guess when you can make others know?

Why wait to become a billionaire when you can do in a twinkling with Twitter?

Or connect with billions with Facebook?

According to three dozen experts who gathered this week in Boston for an innovation conference, a tsunami of health care innovations is sweeping the globe.

These innovations, say the expert schemers and dreamers, will be cost-effective and will boost wellness, prevention, precision treatment, personal and decentralized care at the iPhone, social media, personal, and home-bound levels.

It will be an E for an E, an E-click for an E- click, and an E-bite for an E-bite, one on one for millions.

Well, we shall see.

We shall see innovation and 3000 troops on the ground wipes out Ebola.

We shall see if the over all and individual health of Americans improves.

We shall see if the results match the rhetoric.

We shall see if innovation creates necessary economic growth, requisite market competition, needed consumer choices, and required price transparencies.

And we shall see whether collectivist governments have the wisdom to abet the innovative process or strangle it because it generates that dreaded thing called profit – a universal incentive for prosperity and the betterment of humankind.

Friday, September 19, 2014

President Obama's Judgment V. the People's Judgment

Any social order which can function well with a minimum of leadership will be anathema to the intellectual

Eric Hoffer (1902-1983), American longshoreman, moral and social philosopher, In The True Believer (1951)

I collect Eric Hoffer books. I think of him as "His Earthiness", a man with his feet solidly on the ground.

Among other things, Hoffer has said you cannot trust an intellectual to be President because he does not reflect the sentiments of the people.

Obama considers himself as one of the elite, who knows what needs to be done.

President Obama has inpeccable academic credentials – Columbia University, Harvard Law, and Professor of Constitutional Law at the University of Chicago. He is smart. He is a real, genuine, certified intellectual, with two best-seller books on the New York Times book list. He is a smooth talker. He is facile with words, especially when reading from a teleprompter. He is quick with concepts. He absorbs data and information like a sponge. He is an integral inseparable part of the Media-academic-Washington-elite-policy Complex.

But he may be out of out of touch with the populace, as evidenced by these latest Real Clear Politics polls based on average results of major national polls.

• Obama Job Approval, Approve 41.3%, Disapprove 53.4%

• Direction of Country, Right direction, 27.4%, wrong direction 64.6%

• Approval of Health Law, favor 41.3%, oppose 51.4%

Is it possible the President lacks wisdom and judgment on how best to lead the country, how to get the country behind him on critical issues relating to the economy, to joblessness, to health care, to foreign affairs? Is it possible the President is too long on rhetoric but too short on results?

Does he lack the wisdom to lead the country? Does he understand wisdom of crowds, whose support he needs and who must live under his leadership? Is the President like the man described by Albert Camus (1913-1960), who said, “An intelligent man on one plane can be a fool on the others.”

To Peggy Noonan, a staunch Republican writing in yesterday’s Wall Street Journal, “ The Unwisdom of Barach Obama – Is He Weak? Arrogant? Ambivalent?"

Noonan say the President’s problems– his being out of touch on economic issues, health care, foreign affairs, his own advisers and generals – is not lack of wisdom.

It is simply poor judgment , of not seeing the domestic and global forests as seen by others while looking too intently at his own trees.

“He has very poor judgment. Maybe all this is the president's clever way of letting time pass, letting things play out, so that in a few months the public fever to do something—he always thinks the public has a fever—will be over. And he will then be able to do little, which perhaps is what he wants.But none of this looks clever. It looks like poor judgment beginning to end.”

For President Obama, his day of judgment is approaching in 46 days with the November 4 midterm elections. We shall see then whose judgment prevails - his or that of the people.

Thursday, September 18, 2014

ObamaCare in Perspective

Everything we hear is an opinion, not a fact. Everything we see is a perspective, not the truth.

Marcus Aurelius (121-180 AD)

These days I am spending a lot of my time trying to keep things in perspective.

I am watching the excellent PBS series on the Roosevelts and the different perspectives on Theodore Roosevelt, a Republican Progressive. and Franklin Roosevelt, a Democratic Progressive, both pitting their parties against the rich, and I am reading Karl Rove, “Why A GOP Majority Is Still in Doubt,” WSJ, September 17. The reason, says Rove, is that Democrats have more money and are outspending the GOP $109 million to $85 million on negative TV ads.

This discrepancy makes me wonder, who is the party of the rich?

My aim is to keep matters in perspective, rather than going off half-cocked.

It isn’t easy.

Take the ISIS beheadings of 3 innocent hostages. The beheadings are gruesome, but they may not foretell of the unraveling of Western civilization, an argument advanced by Robert Cohen of the ew York Times
)”The Great Unraveling, September 15).

Or consider today’s Scottish referendum whether to declare independence from England. I doubt this is the end of Scotland if they vote Yea ( Niall Ferguson, “Alone, Scotland Will Be a Failed State," The Telegraph, September 18).

Or, for another matter, take the ObamaCare political situation. The three beheadings, ISIS aggression, and speculation about troops on the ground have pushed ObamaCare into background. ObamaCare, say the pundits, has become a nonfactor in the Senate election (David Nasher, “ObamaCare from Game Changer to Background Noise, “Politico, September 17).

From my perspective, the Senate outcome may or may not seal the fate or keep ObamaCare alive.

• Whether Democrats or the GOP wins the Senator or a tie occurs, given Obama’s veto power, gridlock will continue for the rest of the Obama presidency.

• As pointed out in yesterday’s blog, ObamaCare exchanges cover only 7 million Americans, just 3.2% of the population, and even if 5 million are added in the next enrollment go-around starting November 15, only 3.8% will be insured. If ObamaCare goes as predicted until 2013, 30 million of 9.5% of Americans will be left uninsured.

• The American public opposes ObamaCare but does not want it repealed and wants certain changes kept (young adults covered under parents’ plans and coverage of those with pre-existing conditions). To date, the number of uninsured has been reduced a scant 2%.

• Despite all the hubdub, we sometimes forget a nation’s health system accounts for only 15% of a nation’s health status; life style is 30% and other factors – poverty, inferior education, income differences, and lack of social cohesion ofor the other 55% (Satcher, D, and Pamies, R, Multicultural Medicine and Health , McGraw Hill, 2006),

We forget too that since 1965, when Lyndon Johnson declared the war on poverty, we have spent $15 trillion on poverty and the rate of poverty remains at 15%, the same as it was then.

And finally we tend to neglect the fact that under President Obama, income inequality between the rich and the poor has widened, and income of the middle class has fallen 10%. To paraphrase George Orwell, despite progressive politics, all humans are equal but some remain more equal than others.